Re-Place Implant with Sinus Membrane Perforation?

When the non-osteointegrated implant is removed, the sinus membrane is found to have been perforated.  There is a history of clear discharge immediately postop ~ 1 year ago.  Against the common wisdom, a 5x10 mm dummy implant is inserted with intention to correct the trajectory and 50 Ncm (Fig.1).  With placement of Osteogen plug (presumably for repair of the perforation) and limited amount of Vanilla at the osteotomy, a 5x7.3 mm IS implant with SLA surface treatment is placed (Fig.2, ~ 40 Ncm).  When the implant is further seated (Fig.3 arrow with bone graft coronally *)), its trajectory is within the normal limit (Fig.4 blue line).  If the implant fails again, it must be due to the mild sinus infection.  Bone graft, or preferably Osteogen Plug (collagen with osteoconductive ability) should have been done first.  Mild tenderness exists with use of Water Pik 7 months post 2nd placement (Fig.5).  Uncover shows that the implant is stable.  A 6x3 mm healing abutment is placed.  Next appointment a temporary crown will be fabricated for progressive loading.  The abutment screw needs retightening 8 months post cementation, probably related to poor crown/implant ratio and missing 2nd molar (Fig.6).

Return to Upper Molar Immediate Implant, Armaments, IBS  提升  Xin Wei, DDS, PhD, MS 1st edition 05/31/2018, last revision 03/28/2021